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Mesocaval interposition shunting in the treatment of bleeding oesophageal varices.
Eur J Surg. 1997 Aug; 163(8):569-76.EJ

Abstract

OBJECTIVE

To assess the longterm results of mesocaval interposition shunt in the treatment of bleeding oesophageal varices.

DESIGN

Retrospective study.

SETTING

University hospital, Sweden.

SUBJECTS

60 patients with bleeding oesophageal varices in all Child's classes. 20 of whom were operated on as emergencies, and 40 as elective cases.

INTERVENTIONS

A 14 mm polytetrafluoroethylene graft was used as an interposition shunt between the superior mesenteric vein and the vena cava.

MAIN OUTCOME MEASURES

Rebleeding rate, portal blood flow, hepatic encephalopathy, morbidity, mortality, and survival.

RESULTS

Rebleeding was rare and occurred mainly during the first 4 months after operation, (n = 5) in 10% of the patients, and at the 24 month follow-up, (n = 4) in 11% of the patients. Portal flow was measured preoperatively in 33 patients and in 22 (67%) it was hepatopetal. During follow-up it was reversed and after 24 months no patient had hepatopetal flow. Hepatic encephalopathy was present in 18 patients (20%) during follow-up. Shunts thrombosed in 9 patients (15%), 8 of which required reoperation. There was no operative mortality, but 4 patients (7%) died within 30 days of surgery. The main late cause of death (18/26) was liver failure. The 1 year survival was 80%, the 3 year survival 70% and the 5 year survival 60%.

CONCLUSIONS

The mesocaval interposition shunt gives good longterm results and can be recommended both as an emergency and an elective procedure for patients with portal hypertension and bleeding oesophageal varices that are unresponsive to sclerotherapy.

Authors+Show Affiliations

Department of Surgery, Lund University Hospital, Sweden.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

9298909

Citation

Isaksson, B, et al. "Mesocaval Interposition Shunting in the Treatment of Bleeding Oesophageal Varices." The European Journal of Surgery = Acta Chirurgica, vol. 163, no. 8, 1997, pp. 569-76.
Isaksson B, Hannesson P, Rosén I, et al. Mesocaval interposition shunting in the treatment of bleeding oesophageal varices. Eur J Surg. 1997;163(8):569-76.
Isaksson, B., Hannesson, P., Rosén, I., & Jeppsson, B. (1997). Mesocaval interposition shunting in the treatment of bleeding oesophageal varices. The European Journal of Surgery = Acta Chirurgica, 163(8), 569-76.
Isaksson B, et al. Mesocaval Interposition Shunting in the Treatment of Bleeding Oesophageal Varices. Eur J Surg. 1997;163(8):569-76. PubMed PMID: 9298909.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mesocaval interposition shunting in the treatment of bleeding oesophageal varices. AU - Isaksson,B, AU - Hannesson,P, AU - Rosén,I, AU - Jeppsson,B, PY - 1997/8/1/pubmed PY - 1997/9/23/medline PY - 1997/8/1/entrez SP - 569 EP - 76 JF - The European journal of surgery = Acta chirurgica JO - Eur J Surg VL - 163 IS - 8 N2 - OBJECTIVE: To assess the longterm results of mesocaval interposition shunt in the treatment of bleeding oesophageal varices. DESIGN: Retrospective study. SETTING: University hospital, Sweden. SUBJECTS: 60 patients with bleeding oesophageal varices in all Child's classes. 20 of whom were operated on as emergencies, and 40 as elective cases. INTERVENTIONS: A 14 mm polytetrafluoroethylene graft was used as an interposition shunt between the superior mesenteric vein and the vena cava. MAIN OUTCOME MEASURES: Rebleeding rate, portal blood flow, hepatic encephalopathy, morbidity, mortality, and survival. RESULTS: Rebleeding was rare and occurred mainly during the first 4 months after operation, (n = 5) in 10% of the patients, and at the 24 month follow-up, (n = 4) in 11% of the patients. Portal flow was measured preoperatively in 33 patients and in 22 (67%) it was hepatopetal. During follow-up it was reversed and after 24 months no patient had hepatopetal flow. Hepatic encephalopathy was present in 18 patients (20%) during follow-up. Shunts thrombosed in 9 patients (15%), 8 of which required reoperation. There was no operative mortality, but 4 patients (7%) died within 30 days of surgery. The main late cause of death (18/26) was liver failure. The 1 year survival was 80%, the 3 year survival 70% and the 5 year survival 60%. CONCLUSIONS: The mesocaval interposition shunt gives good longterm results and can be recommended both as an emergency and an elective procedure for patients with portal hypertension and bleeding oesophageal varices that are unresponsive to sclerotherapy. SN - 1102-4151 UR - https://www.unboundmedicine.com/medline/citation/9298909/Mesocaval_interposition_shunting_in_the_treatment_of_bleeding_oesophageal_varices_ L2 - https://medlineplus.gov/gastrointestinalbleeding.html DB - PRIME DP - Unbound Medicine ER -